Cloudy with a chance of Pain

People have long claimed that the weather affects the pain experienced from conditions such as arthritis, and there is plenty of anecdotal evidence of people predicting changes in the weather based on sensation in their joints. Research led by the University of Manchester is using new technology to put this ancient wisdom to the test.

Launched in January 2016, for the first time researchers are using a smartphone app to collect data and investigate the connection between chronic pain and the weather. ‘Cloudy with a Chance of Pain’ research project involves over 9,000 participants. They were asked to record their symptoms each day using the uMotif app on their smartphone. This information is then matched to weather reports from their area, as identified by their smartphone’s location data.

Early results indicate that these age-old beliefs have merit. Analysis of 100 participants in three regions, Norwich, Leeds and London, found that increased hours of sunlight between February and April led to a reduction in the reports of severe pain. However, pain levels were shown to increase during a particularly rainy June, despite the hours of daylight and relative warmth during that month.

The project, a collaboration supported by Arthritis Research UK, uMotif, the Office for Creative Research in New York and the Health eResearch Centre, and led by the University of Manchester, will conclude its data gathering in January 2017. Subsequent analysis will no doubt offer further insights for patients, osteopaths and the wider medical community.

It is hoped that the results of the research project will help people experiencing chronic pain to better predict and manage their symptoms, including the possibility of a ‘pain forecast’ to help people plan ahead. It should also provide healthcare professionals a wealth of information from which they can develop better interventions and treatment plans.

You can find out more about the project by visiting www.cloudywithachanceofpain.com

Foot and Ankle pain

Pain can occur in the foot and ankles for a number of reasons.

The foot and ankle are made up of a number of small bones interconnected by ligaments, muscles and fascia all working together to give the strength, stability and flexibility the foot and ankle needs to function properly.

Common conditions of the foot, ankle and areas which can give rise to pain include:

Acquired flat foot – when the inner side of the foot or inner arch flattens. The foot may roll over to the inner side (known as over-pronation). It is often apparent if the heels of shoes wear out quickly and unevenly. Over-pronation can damage your ankle joint and achilles tendon (the tendon at the back of your ankle) and can also cause shin pain. Symptoms can include, pain, swelling, change in foot shape and knee pain or swelling.

Plantar fasciitis– is pain and inflammation in the plantar fascia – the tough fibrous band of tissue that supports the arches of the foot and runs under the small bones from the underside of the heel and sole towards the toes, Often, people who have plantar fasciitis describe it as a sharp pain, most often under the heel or instep of the foot. It tends to be made worse by standing for long periods of time in poor footwear. Sufferers commonly mention that it is worse when standing after being off their feet for a long time, and it can hurt more putting the foot on the floor first thing in the morning. The sole of the foot can occasionally feel a little numb, tingly or swell slightly. In some cases of plantar fasciitis, a small spur of bone can grow where the plantar fascia attaches and pulls on the heel which can cause a sharp pain.

Achilles painThe Achilles tendon is formed by the tendon of the two calf muscles, the gastrocnemius and soleus coming together and attaching onto the bone at the back of the heel called the calcaneus) Pain, inflammation or tendonitis in the Achilles can cause pain and tightness in this area.

Sprained ankle –  Typically the result of a sudden twisting or “going over” on the ankle joint and more commonly it is the ligaments on the outside of the ankle that are strained. Typical symptoms are swelling, bruising, pain and instability of the ankle. Sometimes an x-ray is required to rule out any fracture. Rest, ice, elevation and compression are often advisable in the first 24 to 48 hours.

How can an osteopath help with foot and ankle pain?

  • Depending on the diagnosis and your age and fitness we can use a variety of gentle massage and manipulative techniques to increase the mobility of the joints and the flexibility of the muscles in the foot.
  • We will often look at muscles and joints in the lower limb, the knee, hip and lower back and may treat any joint restrictions and muscle tightness we find there. Often improving the movement in the joints of the lower will help the foot and ankle function better.
  • We may offer specific balancing, strengthening or loosening exercises
  • We may offer advice on strapping and brace supports, footwear and any lifestyle factors that might be hindering healing. We may refer you to a podiatrist for their opinion and specialist foot supports
  • X-rays, scans or other tests may be required to make a diagnosis  and we may refer you to your  GP for any additional  investigations and treatment  such as advice on pain killers and anti-inflammatory medications

Persistent Pain

472815 We all feel pain from time to time. When someone injures themselves, specific nerves recognise this as pain, which in turn triggers the body’s repair mechanism. As the problem resolves, the pain tends to improve and usually disappears within 3-6 months. This type of pain could be argued to be beneficial: if it hurts, you are likely to try and avoid doing whatever it is that has caused the pain in the future, so you are less likely to injure yourself in that way again. Occasionally the pain continues even after tissue healing has finished. When pain continues after this point, it becomes known as persistent (or is sometimes referred to as chronic) pain. This type of pain is not beneficial and is a result of the nerves becoming over-sensitised, which means that a painful response will be triggered much more easily than normal. This can be unpleasant, but doesn’t necessarily mean that you are doing yourself any harm simply by moving. You could think of this as a sensitive car alarm that goes off in error when someone walks past (for more information on how pain works, visit: https://www.youtube.com/watch?v=QUrKgv43W2c ).

Persistent pain is very common and effects over 14 million people in the UK alone. It often does not respond to conventional medical interventions and needs a different kind of approach, but there are many things that you can do to manage your pain yourself with the support of your osteopath, your family and loved-ones. Keeping active, performing exercises and stretches can help, learning to pace your activities so that you don’t trigger a flare-up of your pain as well as setting goals and priorities are all very important and can help you to maintain a fulfilling lifestyle.

308248 For more information on how to manage your persistent pain, speak to us on 07737 416906 or email wiltshire.osteopaths@gmail.com or visit http://www.paintoolkit.org/

Arthritis and Osteopathy

Arthritis and Osteopathy

knie schmerzen 2Arthritis is common in older people – although no-one can cure arthritis, you may find it useful to see an osteopath.  Broadly speaking, arthritis can be divided into two types – Inflammatory and Degenerative.
The degenerative form is what we call Osteoarthritis (OA), more commonly described as ‘wear and tear’.
Patients usually feel this in weight bearing areas, usually their knees, hips or spine.
The classic features of pain, stiffness and restricted mobility may often be eased and improved with skilled osteopathic treatment.

Inflammatory arthritis such as Rheumatoid Arthritis (RA) is generally a systemic disease, ie affecting not just the joints but the whole body. Like osteoarthritis, it produces severe pain, stiffness and often deformity. Osteopathy may be helpful in addition to medication.

Osteopaths treat patients with arthritis every day. You may not have to put up with your pain!  Our treatments can do a great deal to reduce pain, ease swelling and improve the mobility and range of joint movement.

Osteopathic treatment is a hands-on approach offering a package of care that is personalised to you.  Treatment is aimed at improving mobility and reducing inflammation by using gentle, manual osteopathic techniques on joints, muscles and ligaments. You will be given positive advice related to your lifestyle about how you use your body. Age is no barrier to osteopathy since each patient is considered individually and treatment is gentle.

If the worst happens and conservative management from an osteopath can no longer manage the patient’s symptoms from hip and knee arthritis, a joint replacement may be required.

Dr Mike Evans provides a YouTube video that is designed to prepare patients in the best possible way for hip or knee replacement surgery. It discusses ways of increasing the chances of a positive outcome from surgery and anticipating common problems helping to manage expectations and to reduce patient anxiety.
The seven minute video clip suggests patients to seek strengthening exercises prior to surgery and encourages them to participate in rehabilitation (that might be provided by you as an osteopath) after.

The iO also produces a specific information leaflet for our patients focused at explaining how osteopathy can help, entitled “As You Get Older”.

Resources and Arthritis Information:

Excluding major catastrophic events causing premature death, aging and its associated conditions will affect all of us eventually. In the UK, it is estimated that 10 million people are affected by arthritis. Eight million of these live with the symptoms of the age related changes associated with osteoarthritis and these statistics are set to increase as a result of our ageing population. Musculoskeletal conditions in general have been identified as the main reason for the predicted rise in the numbers of older people who will become dependent on health and social care services over the next 25 years.

The iO (Institute of Osteopathy) Osteopathic Census suggests that over 80% of osteopaths treat patients over the age of 65 years often or almost exclusively, yet very few osteopaths specialise in geriatric medicine and there are few osteopathic courses that focus on the osteopathic approach towards the specific health needs of this growing patient group.

Have you ever been told that there is nothing to be done about the symptoms of old age? Hopelessness and depression are a major silent problem in the elderly.  However, knowing where to find support and information that empowers those living with age related changes to self-manage can take some of the fear out of ageing and osteopaths have an important role to play in addressing this need.

The following sites provide clear, reassuring and evidence based advice resources that can supplement advice given by your osteopath in the consulting room and improve your care:

ArthritisCareLogoArthritis Care are the UK’s largest charity working with and for people living with arthritis. They are a user-led charity which means people living with arthritis are at the heart of their work.

Founded in 1947, a year before the UK’s National Health Service was established, they provide support and teach people how to manage their condition through a self-management training program and support network. Arthritis Care also provide information booklets, the ‘Arthritis News’ eBulletin, four respite holiday hotels, and run local, national and international campaigns including Arthritis Care Awareness Week which will begins on 18 May 2015. You can access their website here.

ArthritisResearchUKLogoArthritis Research UK are the UK’s fourth largest medical research charity and fund scientific and medical research into all types of arthritis and musculoskeletal conditions, including osteoarthritis, rheumatoid arthritis, back pain and osteoporosis. They publish over 60 high quality evidence based information booklets and online content designed to reassure and inform patients about their condition, its treatment, medications, therapies and self-management techniques as well as providing pragmatic living aids such as key turners, jar and can openers and pick-up aids for those that find mobility a problem.

Sufferers, or people who want to know more about arthritic conditions can look at the Arthritis Research UK eShop, or can download information (free) by clicking on the ‘shop’ and then ‘publications’ tabs here.

If you feel you would like to book an appointment, please call 07737 416906 (all clinics).

Lower Back Pain

Back pain is very common – according to a survey published in 2000 almost half the adult population of the UK (49%) report low back pain lasting for at least 24 hours at some time in the year.  It is estimated that four out of every five adults (80%) will experience back pain at some stage in their life. (1)

In most cases it is very difficult to identify a single cause for back pain. In about 85% of back pain sufferers no clear pathology can be identified. (2)

The following factors could contribute to back pain:

  • Having had back pain in the past, smoking and obesity. (3)
  • Physical factors such as heavy physical work, frequent bending, twisting, lifting, pulling and pushing, repetitive work, static postures and vibrations. (4)
  •  Psycho-social factors such as stress, anxiety, depression, job satisfaction, mental stress. (3, 5)

Nearly 40% of back pain sufferers consulted a GP for help.  10% visited a practitioner of complementary medicine (osteopaths, chiropractors and acupuncturists). (6)

Common causes of low back pain include:

  • Muscular strain – sometimes you can ‘pull a muscle’ in your back, resulting in a small tear or sprain in your muscle.
  • Disc problems – sometimes the discs between the vertebrae may become weaker and bulge out.   In extreme cases, this may lead to a prolapsed disc.
  • Spinal stenosis – the spinal column runs through a narrow opening in your vertebrae.  If this opening becomes too narrow, the nerves may become trapped, which causes pain.
  • Collapsed vertebra – the vertebrae give much of the structural support to the spine but these may become damaged as a result of disease or injury.  Severe osteoporosis may result in a vertebra collapsing and by doing so, disturb the surrounding structures.
  • Inflammation of sacro-iliac joints, or lumbar spine facet joints
  • ‘Wear and tear’ ie arthritis/spondylitis of the lumbar spine

If you have a physical job, sit or stand for long periods, or are in poor physical condition, you are at greater risk of developing lower back pain.

Most people associate back pain with physical risk factors such as heavy lifting, twisting and bending and awkward postures.  These can contribute to back pain or exacerbate any existing pain. Therefore you should pay attention to controlling these factors by, for example, using manual handling aids (lift, hoists etc) and ergonomically assessed workstations.

Other risk factors of a physical nature include vibration (for example the vibrations that a driver experiences when driving a car or truck), repetitive work and static postures.

Emotional stress and long periods of inactivity can also make symptoms appear worse.

Structure of the spine:

Understanding a little basic anatomy can help you understand the nature of your pain and where it’s arising from.

Your back consists of many different structures that all have to work together.

Your spinal column is comprised of 33 vertebrae, with discs (like shock absorbers) in-between them.  You have 7 in your neck (Cervical vertebrae), 12 in your middle back (Thoracic vertebrae), and 5 in your lower back (Lumbar vertebrae). You have 5 vertebrae which are fused together to form your Sacrum, attached to which are 4 vertebrae, which are also fused, that form your Coccyx (tailbone).

The shape and size of these vertebrae changes from the top to the bottom of the spine – cervical vertebra are small, and are designed for movement and flexibility, whilst lumbar vertebrae are much bigger, being responsible for the weight bearing of almost all of the upper body.

As the vertebrae stack up one on top of the other, a small gap called a foramen is formed.  Pairs of spinal nerves branch away from the central spinal cord and travel through these foramen to supply organs, limbs etc.

The spinal cord is encased in a ring of bone formed by the front and the back of the vertebra, and this runs from the base of the brain to the bottom of the spinal column.

The discs between the vertebrae are more formally known as intervertebral discs.  They are made up of a soft jelly like substance called the nucleus, which is held inside a tough, elastic and fibrous outer casing known as the annulus.  The vertebrae and the discs together are known as the spinal column.  This is supported by many muscles, tendons and ligaments.  Their function is to provide strength and stability to the spinal column.

The muscles are connected to your bones with tendons – when a muscle contracts, the forces are passed on to the skeletal system via the tendons. This ensures that a muscle contraction results in a movement of a certain body part. The role of a ligament is to provide stability to a joint – however, ligaments are also flexible to a certain degree, so they can stretch or contract when the joint moves.

It could be thought that any abnormalities in the structure or functioning of your back will result in pain, but this is not necessarily true.  People have very different backs and it is difficult to define a ‘normal’ structure. Some people with severe deformities may not experience any back pain while others who appear to have ‘normal’ backs experience severe pain.

Osteopathic Treatment for Lower Back Problems:

Although lower back pain is often very painful, the good news is that few people have a major problem with the bones or joints of their backs.

A good proportion of lower back problems can be resolved using non-surgical methods.  Manipulation by a specialist practitioner followed by mobilisation and exercises has been proven to be the most effective treatment for acute low back pain (UK BEAM BMJ 2004; 329; 1377)

Prevention is better than cure, and it is often easier for an osteopath to treat underlying stresses and strains when there is no current back pain. You do not have to have the pain on the day of the treatment.

Likewise, you do not have to wait for a particularly painful episode to settle before visiting an osteopath.  Most back pain is easier to treat in its early stages. It is also important for the longer term to minimise the potential for structural damage or arthritis, which can be caused by wear and tear through strain on weak areas of the spine, by getting treatment when it is needed.

During your consultation, the osteopath will take a full history of your condition, and also ask questions relating your current and past state of health.  It is helpful if you could bring a list of any medications you may be currently taking.  Once a diagnosis had been made, the osteopath will discuss it with you and outline what the best course of treatment would be.  Occasionally, further diagnostic tests may be required, such as x-rays, MRI scans or blood tests  – for these you be referred back to your GP/Specialist.

Osteopathic treatment of lower back pain may include one or more of the following techniques:

  • High velocity low amplitude thrusts (HVT) – the osteopath applies a high-velocity low amplitude thrust to the joint to reduce any restricted movement.  This is painless and makes a small ‘clicking’ or ‘popping’ sound.
  • Myofascial Release – The osteopath may use this soft tissue therapy to release muscular shortness and tightness.
  • Muscle Energy (MET) – The osteopath applies a counterforce to the muscles while they are being used in a specific position and direction, such as when flexing.
  • Soft Tissue Mobilization / Massage – The osteopath uses rhythmic stretching, deep pressure or traction techniques to engage the muscle area around the spine.

The average patient usually responds positively within three to six treatments, but more, or indeed fewer treatments may be required depending on the nature of what is being treated and the individual’s circumstances and past history of the condition.  A chronic lower back problem may well take considerably longer to resolve.

After your treatment, you may well be given a series of exercises to do, and/or postural advice if your osteopath feels this would be of benefit to you.

 

Treating lower back dysfunction Photo copyright of Kampfner Photography

 

References:

(1)    Palmer KT, Walsh K, et al. Back pain in Britain: comparison of two prevalence surveys at an interval of 10 years BMJ 2000;320:1577-1578.

(2)    Nachemson AL, Waddell G, Norlund AI. Epidemiology of neck and low back pain. In: Nachemson AL & Jonsson E (eds). Neck and back pain: The scientific evidence of causes, diagnosis and treatment. Philadelphia: Lippencott Williams & Wilkins, 2000.

(3)    Burton AK, Balague F, et al. European guidelines for prevention in low back pain. Eur Spine J 2006:15(suppl 2):S136- S168

(4)    Andersson GBJ. The epidemiology of spinal disorders. In: Frymoyer JW (eds) The adult spine: Principles and practice.  Philadelphia: Liipincott-Raven, 1997.

(5)    Hoogendoorn WE, van Poppel MNM, et al. Systematic review of psychosocial factors at work and in private life as risk factors for back pain. Spine 2000;25:2114-2125.

(6)    Department of Health Statistics Division. The prevalence of back pain in Great Britain in 1998. London: Government Statistical Service, 1999

The Great British Pain in the Neck

  • Britons are more likely to suffer from neck pain
  • Massaging the spine is more effective than medicine in short and long term

People living in Britain are among those most likely to suffer neck pain according to an article published this month.  It states that those living in high-income countries are more susceptible to the problem than those living in low or middle-income countries.

 

The study of neck pain treatment, published in Annals of Internal Medicine earlier this month, also reveals that women are more likely than men to experience neck pain and that the problem is particularly prolific among office and computer workers.

Britons are exceptionally hardworking and driven,  with the UK ranked as the 13th most prosperous country out of the 130 countries measured in the 2011 Legatum Prosperity Index.  Much of the work in high-income countries, including the UK, is conducted at a desk where ergonomics and stress are common factors that can result in neck pain and exacerbate existing conditions.

According to the article, spinal manipulation, which is practiced by osteopaths and some other health practitioners, was more effective at relieving symptoms than medication.  Medication, whether over-the-counter or prescribed by GPs, is often a popular choice among time-poor workers who are reluctant to take time off for expert treatment.  However patients who were taught self-massage techniques rather than solely having to rely on treatment provided by professionals also benefitted more than those taking medication.

Kelston Chorley, Head of Professional Development at the British Osteopathic Association (BOA) says: “These research findings are positive for individuals, employers and employees.  Pain relief medication can be expensive and learning self-massage techniques mean individuals can be empowered to help manage their pain.  Further, where medication is ineffective, this can result in on-going problems that could have been resolved earlier and may even worsen as a result.  This can mean people have to take time off work for extended periods.

“An osteopath will usually provide some initial treatment to help correct any underlying cause for the condition and will always provide self-help strategies for neck pain so patients can manage their condition in the future.”

The article also says that mobilisation, described by the BOA as repetitive movements of joints to free up restrictions and increase the movement of joints and surrounding tissues, may be a better first treatment for non-specific neck pain than manipulation, described as unlocking restricted joint and surrounding tissues with a single highly specific movement, which can be an uncomfortable experience for some patients.

Kelston concludes: “In many cases of acute or chronic neck problems manipulation is not always the first line of treatment by an osteopath. Using a combination of soft tissue massage, mobilisations and self-help exercises often proves to be a more appropriate solution than the “neck clicking” commonly associated with manipulation.”

To read the article in full, please visit:

http://www.annals.org/content/156/1_Part_1/1.abstract?aimhp